| 闭合复位两种穿针方式治疗儿童Gartland Ⅲ型肱骨髁上骨折的疗效对比 |
| Comparison of the efficacy of closed reduction with two types of piercing methods in the treatment of Gartland type Ⅲ supracondylar humeral fractures in children |
| 投稿时间：2024-07-15 |
| DOI：10.3969/j.issn.1672-5972.2025.02.011 |
| 中文关键词: 儿童 肱骨髁上骨折 Gartland Ⅲ型 闭合复位 穿针方式 克氏针固定 |
| 英文关键词:Children Supracondylar humeral fracture Gartland type Ⅲ Closed reduction Piercing method Kirschner wire fixation |
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| 中文摘要: |
| 目的 比较闭合复位经皮单侧穿针固定与闭合复位经皮交叉穿针固定治疗儿童Gartland Ⅲ型伸直型肱骨髁上骨折的临床疗效，探讨冠状面不同类型骨折线走向与穿针方式的关系。方法 回顾性分析2021年1至2023年6月晋城市人民医院收治的46例Gartland Ⅲ型伸直型肱骨髁上骨折的儿童资料，按治疗方法的不同分为A、B两组：A组（23例）采用闭合复位经皮桡侧3根克氏针穿针固定，B组（23例）采用闭合复位桡侧2根+尺侧1根克氏针经皮交叉穿针固定。比较两组的手术时间、骨折愈合时间、提携角、Baumann角、肘关节屈伸活动度及前臂旋转活动度、并发症情况，采用Flynn肘关节功能标准评价两组的优良率。结果 随访6 ～ 12个月，平均（8.00±2.12）个月。A组的手术时间短于B组，差异有统计学意义（P＜0.05）；A组的提携角小于B组，Baumann角大于B组，两组比较差异无统计学意义（P＞0.05）。术后6个月随访时，两组患儿在肘关节屈伸活动度、前臂旋转活动度方面，差异无统计学意义（P＞0.05）。末次随访两组均无骨化性肌炎发生；A组有2例肘内翻，B组有1例肘外翻；A组无医源性尺神经损伤，B组有1例；两组总体并发症发生率比较，差异无统计学意义（P＞0.05）。A组的Flynn评分优良率为82.61%（19/23），B组的Flynn评分优良率为86.96%（20/23），在临床疗效方面的差异无统计学意义（P＞0.05）。结论 ①两种穿针方式治疗Gartland Ⅲ型肱骨髁上骨折均可获得满意疗效，单侧穿针手术时间短、尺神经损伤发生率低，交叉穿针可获得更加可靠的固定以维持术中的复位效果；②根据冠状面不同类型的骨折线走向，选择适合的穿针固定方式。 |
| 英文摘要: |
| Objective To compare the efficacy of closed reduction combined with percutaneous unilateral pinning fixation and closed reduction combined with percutaneous cross pinning fixation in the treatment of Gartland type Ⅲ extended supracondylar humeral fractures in children, and to explore the relationship between the direction of different types of fracture lines in the coronal plane and the pinning method.Methods A retrospective study was conducted on 46 children with Gartland type Ⅲ extended supracondylar humeral fractures admitted to Jincheng People's Hospital from January 2021 to June 2023. They were divided into group A and group B according to the different treatment methods: Group A (23 cases) underwent closed reduction and percutaneous fixation with three radial Kirschner wires, and group B (23 cases) underwent closed reduction and percutaneous cross-pinning fixation with two radial and one ulnar Kirschner wires. The two groups were compared in terms of operation time, fracture healing time, carrying angle, Baumann angle, elbow flexion and extension range of motion, forearm rotation range of motion, and complications. The Flynn elbow function standard was used to evaluate the excellent and good rates of the two groups.Results The follow-up period ranged from 6 to 12 months, with an average of (8.00±2.12) months. The operation time in group A was shorter than that in group B (P<0.05). The carrying angle in group A was smaller than that in group B, and the Baumann angle was larger than that in group B, but the difference was not statistically significant (P>0.05). At the 6-month follow-up after surgery, there was no significant difference in elbow flexion and extension range of motion and forearm rotation range of motion between the two groups (P>0.05). No myositis ossificans occurred in either group at the last follow-up; there were 2 cases of cubitus varus in group A and 1 case of cubitus valgus in group B; there was no iatrogenic ulnar nerve injury in group A and 1 case in group B; there was no significant difference in the overall complication rate between the two groups (P>0.05). The excellent and good rate of Flynn score in group A was 82.61% (19/23), and the excellent and good rate of Flynn score in group B was 86.96% (20/23). There was no significant difference in clinical efficacy (P>0.05).Conclusion ① Both insertion methods can achieve satisfactory results in the treatment of Gartland type Ⅲ supracondylar fractures. The unilateral insertion fixation has a short operation time and a low incidence of ulnar nerve injury. The cross insertion fixation can obtain more reliable fixation to maintain the reduction effect during the operation. ② According to the different types of fracture lines on the coronal plane to choose the appropriate pinning fixation method. |
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